Figure 1. The stakeholder groups constructing Living Labs targeting
EIDs, adapted and updated from Steen & van Bueren, 2017
(70).
LLs are fit to address the issue of feasibility and temporary
collaborations through an inclusive, planned process, where solutions
are planned in a precautionary manner. Participants representing diverse
stakeholders and sectors jointly create an intervention plan, which aims
to accommodate interests of all sides and respects limitations. Given
the highly diverse legal environment on various regional levels, LLs
consist of a select group of stakeholders with expertise relevant to the
scientific, legal, geographical, economical and social conditions of a
well-defined pathogen system. This creates a highly flexible and
adaptable tool operating based on specific guidelines, but always
adopted to the local environment.
LLs addressing disease prevention on a regional level should furthermore
always be in close collaboration with Citizen Science and community
programs engaging members of the exposed, susceptible population. The
following section described the tools necessary for dealing with EIDs on
a local scale.
Local
In case of a novel emergence, the initial absence of available
information leaves an extremely narrow time window for reactive action.
Additionally, due to the cultural and socio-economic diversity of
directly affected communities, disease management often suffers from low
feasibility and inefficient implementation
(71–73). Similar
as described for the regional scale, the DAMA protocol facilitates
bottom-up processes and the involvement of local actors in both data
gathering and generating solutions. Building working relationships with
members and local experts of exposed communities creates mutual benefits
by increasing the efficiency of implementing disease control measures,
and building trust and collaboration between authorities, science and
society.
Citizen/Community Science
Citizen or Community Science (CS) initiatives are founded to include
locals as active participants in research projects targeting their
direct environment. With insights provided by patients, farmers,
students, hunters and hikers, CS has been invaluable in tracking insect
and tick vectors
(55,74), avian
influenza in urban environments
(54) and wildlife health
(75).
Similar to preparation, disease prevention also relies heavily on
completing scientific data with traditional insights and observations
regarding reservoirs. CS programs provide an opportunity for outreach
and contact with communities most exposed to emergence (e.g. urban
minorities, underserved communities, students, rural farmers, etc.).
Emphasis is placed on establishing communication channels and training
programs between susceptible communities, public health and scientific
research, creating long-term science-practice collaborations, which will
serve as a foundation for continued monitoring and early warning
systems. When mapping the distribution of a reservoir and/or vector of a
suspected pathogenic microbe, local expertise and traditional insights
on reservoir behaviour and distribution will be fundamental to
conducting efficient monitoring. A further benefit of such initiatives
is building the science - society trust bridge, which faces a difficult
test during a public health emergency. Finally, including locals in the
process, including in LLs (see above), grants ownership over outcomes
and intervention plans to those on whom policies are acted on.
When targeting a community, it is just as important to make sure the
members involved are relevant to the research and policy issue at hand,
as it is to contact groups that are likely to positively respond to this
research collaboration. Local organisations not only have in-depth
knowledge about their community members, they already have the relevant
network and infrastructure for reaching out and advertising
opportunities. Although each program should consider the local setting
and structure of the community, good examples to reach out to are
(Figure 2.):
Community-based organisations - these organisations are
founded and run by members of the community advocating for particular
issues and rights, and therefore collect proactive groups of locals
that could be approached with a CS initiative. Typical examples are
Environmental Protection Groups, Neighbourhood Associations or
Volunteering Clubs.
Educational institutions - gathering young members of the
community who are currently or have been exposed to scientific
knowledge makes educational institutions a prime target for CS
programs, often building cohorts of volunteers who remain active in
the research program even after leaving the institution. High schools,
GED (General Educational Development) programs or colleges are only a
few examples.
When designing a CS program, we aim to establish a long-term mutually
beneficial relationship with key members of the community. This requires
not only initial investment into recruiting data samplers, but must also
run parallel with feedback and networking activities. The long-term goal
of successful CS programs is not necessarily constant data influx, but
the foundation of a dynamic network of locally trained experts and
researchers which remain in touch and can be mobilised or expanded. This
permanent working relationship is further fostered by selecting reliable
and committed participants for leadership positions within the CS
program.
Paraprofessional networks
Although initiatives targeting health disasters have been widely
introduced, including the integrated ‘One Health’ surveillance, a common
issue is barriers in the way of societal implementation, such as lack of
efficient communication, fluctuating compliance and engagement, and
territorial fragmentation
(76). Disease prevention
relies on long-term monitoring of both pathogen and reservoir
populations; it is therefore crucial to have a permanent program in
place that engages citizens, collects data and knowledge and feeds
information back to the community.
After establishing a CS program, opportunities must be provided for
consistently involved, engaged members to immerse within the project,
gain agency and ownership over the issue at hand. Selecting candidates
for leadership positions creates a network of so-called
paraprofessionals who are then able to head particular tasks, assist
with training, lead recruitment and participate in feedback. A regular
income assigned to such positions also increases livelihood, as well as
trust and cooperation with authorities. Paraprofessionals have been
indispensable in addressing livestock
(77) and human diseases
(78), and should therefore
be cornerstones of EID prevention efforts.